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Ranjan R, Ken‐Dror G, Martinelli I, Grandone E, Hiltunen S, Lindgren E, Margaglione M, Duchez VLC, Triquenot Bagan A, Zedde M, Giannini N, Ruigrok YM, Worrall BB, Majersik JJ, Putaala J, Haapaniemi E, Zuurbier SM, Brouwer MC, Passamonti SM, Abbattista M, Bucciarelli P, Lemmens R, Pappalardo E, Costa P, Colombi M, Aguiar de Sousa D, Rodrigues S, Canhão P, Tkach A, Santacroce R, Favuzzi G, Arauz A, Colaizzo D, Spengos K, Hodge A, Ditta R, Pezzini A, Coutinho JM, Thijs V, Jood K, Tatlisumak T, Ferro JM, Sharma P. Coma in adult cerebral venous thrombosis: The BEAST study. Eur J Neurol 2024; 31:e16311. [PMID: 38646961 PMCID: PMC11235700 DOI: 10.1111/ene.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND PURPOSE Coma is an independent predictor of poor clinical outcomes in cerebral venous thrombosis (CVT). We aimed to describe the association of age, sex, and radiological characteristics of adult coma patients with CVT. METHODS We used data from the international, multicentre prospective observational BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. Only positively associated variables with coma with <10% missing data in univariate analysis were considered for the multivariate logistic regression model. RESULTS Of the 596 adult patients with CVT (75.7% women), 53 (8.9%) patients suffered coma. Despite being a female-predominant disease, the prevalence of coma was higher among men than women (13.1% vs. 7.5%, p = 0.04). Transverse sinus thrombosis was least likely to be associated with coma (23.9% vs. 73.3%, p < 0.001). The prevalence of superior sagittal sinus thrombosis was higher among men than women in the coma sample (73.6% vs. 37.5%, p = 0.01). Men were significantly older than women, with a median (interquartile range) age of 51 (38.5-60) versus 40 (33-47) years in the coma (p = 0.04) and 44.5 (34-58) versus 37 (29-48) years in the non-coma sample (p < 0.001), respectively. Furthermore, an age- and superior sagittal sinus-adjusted multivariate logistic regression model found male sex (odds ratio = 1.8, 95% confidence interval [CI] = 1.0-3.4, p = 0.04) to be an independent predictor of coma in CVT, with an area under the receiver operating characteristic curve of 0.61 (95% CI = 0.52-0.68, p = 0.01). CONCLUSIONS Although CVT is a female-predominant disease, men were older and nearly twice as likely to suffer from coma than women.
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Affiliation(s)
- Redoy Ranjan
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
| | - Gie Ken‐Dror
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
| | - Ida Martinelli
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
- Moncucco Hospital Group, Moncucco ClinicHematology ServiceLuganoSwitzerland
| | - Elvira Grandone
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
- Medical and Surgical DepartmentUniversity of FoggiaFoggiaItaly
| | - Sini Hiltunen
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Veronique Le Cam Duchez
- University of Rouen Normandy, Inserm U1096, CHU RouenVascular Hemostasis Unit and Inserm CIC‐CRB 1404RouenFrance
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke UnitLocal Health Unit–Authority IRCCS of Reggio EmiliaReggio EmiliaItaly
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, Neurological InstituteUniversity of PisaPisaItaly
| | - Ynte M. Ruigrok
- UMC Utrecht Brain Centre, Department of Neurology and NeurosurgeryUniversity Medical Centre UtrechtUtrechtthe Netherlands
| | - Bradford B. Worrall
- Departments of Neurology and Public Health SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Jukka Putaala
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Elena Haapaniemi
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Susanna M. Zuurbier
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam NeuroscienceUniversity of AmsterdamAmsterdamthe Netherlands
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam NeuroscienceUniversity of AmsterdamAmsterdamthe Netherlands
| | - Serena M. Passamonti
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Maria Abbattista
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Robin Lemmens
- Department of Neurosciences, Experimental NeurologyKU Leuven–University of LeuvenLeuvenBelgium
- VIB Centre for Brain & Disease ResearchLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Emanuela Pappalardo
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Paolo Costa
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Marina Colombi
- Division of Biology and Genetics, Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Diana Aguiar de Sousa
- Stroke CentreLisbon Central University HospitalLisbonPortugal
- CEEM and Institute of Anatomy, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Sofia Rodrigues
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
- Department of Neurosciences, Hospital of Santa MariaUniversity of LisbonLisbonPortugal
| | - Patrícia Canhão
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
- Department of Neurosciences, Hospital of Santa MariaUniversity of LisbonLisbonPortugal
| | | | - Rosa Santacroce
- Medical Genetics, Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Giovanni Favuzzi
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
| | - Antonio Arauz
- Stroke ClinicNational Institute of Neurology and Neurosurgery Manuel Velasco SuarezMexico CityMexico
| | - Donatella Colaizzo
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
| | - Kostas Spengos
- Department of Neurology, Eginition HospitalUniversity of Athens School of MedicineAthensGreece
| | - Amanda Hodge
- Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Reina Ditta
- Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Alessandro Pezzini
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
- Stroke Program, Department of EmergenciesParma University HospitalParmaItaly
| | - Jonathan M. Coutinho
- Department of Neurosciences, Experimental NeurologyKU Leuven–University of LeuvenLeuvenBelgium
- VIB Centre for Brain & Disease ResearchLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Turgut Tatlisumak
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - José M. Ferro
- Instituto de Medicina Molecular João Lobo AntunesUniversidade de LisboaLisboaPortugal
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
- Department of Clinical NeuroscienceImperial College Healthcare NHS TrustLondonUK
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Theologou R, Nteveros A, Artemiadis A, Faropoulos K. Rare Causes of Cerebral Venus Sinus Thrombosis: A Systematic Review. Life (Basel) 2023; 13:life13051178. [PMID: 37240823 DOI: 10.3390/life13051178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/15/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) is a rare manifestation of thrombosis commonly caused by thrombophilia, hormonal-related factors, non-cerebral malignancy, and hematologic diseases. The aim of this review was to identify and summarize rare CVST cases. Methods: A literature search of the Medline database was performed in November 2022. CVST cases of a common cause were excluded. Demographic and clinical data were extracted. Eligible cases were categorized into inflammatory, primary CNS tumors, post-operative/traumatic, and idiopathic groups to allow statistical group comparisons. Results: 76 cases were analyzed. Idiopathic CVST was most frequently reported followed by inflammatory, post-traumatic/operative and primary CNS tumor causes. The intracranial hemorrhage rate was 23.7% and it was found to increase in the inflammatory group (45.8%). Anticoagulation was used in the majority of cases and it was significantly related to better outcomes. A low rate of anticoagulation use (43.8%) was found among CVST cases in the post-operative/traumatic group. The overall mortality rate was 9.8%. 82.4% of patients showed significant early improvement. Conclusions: Most rare CVST cases were either of idiopathic or inflammatory origin. Interestingly, hemorrhage occurred often he idiopathic CVST cases. A low rate of anticoagulation use in neurosurgical CVST cases after trauma or head surgery was observed.
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Affiliation(s)
| | - Antonios Nteveros
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
| | - Artemios Artemiadis
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus
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Aguiar de Sousa D, Lucas Neto L, Arauz A, Sousa AL, Gabriel D, Correia M, Gil-Gouveia R, Penas S, Carvalho Dias M, Correia MA, Carvalho M, Canhão P, Ferro JM. Early Recanalization in Patients With Cerebral Venous Thrombosis Treated With Anticoagulation. Stroke 2020; 51:1174-1181. [DOI: 10.1161/strokeaha.119.028532] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The hypothesis that venous recanalization prevents progression of venous infarction is not established in patients with cerebral venous thrombosis (CVT). Evidence is also scarce on the association between residual symptoms, particularly headache, and the recanalization grade. We aimed to assess, in patients with CVT treated with standard anticoagulation, (1) the rate of early venous recanalization, (2) whether lack of early recanalization was predictor of parenchymal brain lesion progression, and (3) the prevalence and features of persistent headache according to the recanalization grade achieved.
Methods—
PRIORITy-CVT (Pathophysiology of Venous Infarction – Prediction of Infarction and Recanalization in CVT) was a multicenter, prospective, cohort study including patients with newly diagnosed CVT. Standardized magnetic resonance imaging was performed at inclusion (≤24 hours of therapeutic anticoagulation), days 8 and 90. Potential imaging predictors of recanalization were predefined and analyzed at each anatomical segment. Primary outcomes were rate of early recanalization and brain lesion progression at day 8. Secondary outcomes were headache (days 8 and 90) and functional outcome (modified Rankin Scale at days 8 and 90).
Results—
Sixty eight patients with CVT were included, of whom 30 (44%) had parenchymal lesions. At the early follow-up (n=63; 8±2 days), 68% (n=43) of patients had partial recanalization and 6% (n=4) full recanalization. Early recanalization was associated both with early regression (
P
=0.03) and lower risk of enlargement of nonhemorrhagic lesions (
P
=0.02). Lesions showing diffusion restriction (n=12) were fully reversible in 66% of cases, particularly in patients showing early venous recanalization. Evidence of new or enlarged hemorrhagic lesions, headache at days 8 and 90, and unfavorable functional outcome at days 8 and 90 were not significantly different in patients achieving recanalization.
Conclusions—
Venous recanalization started within the first 8 days of therapeutic anticoagulation in most patients with CVT and was associated with early regression of nonhemorrhagic lesions, including venous infarction. There was an association between persistent venous occlusion at day 8 and enlargement of nonhemorrhagic lesions.
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Affiliation(s)
- Diana Aguiar de Sousa
- From the Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/CHULN, University of Lisbon, Portugal (D.A.d.S., M.C.D., P.C., J.M.F.)
- Institute of Anatomy, Faculdade de Medicina, University of Lisbon (D.A.d.S., L.L.N., S.P.)
- Instituto de Medicina Molecular, Lisbon (D.A.d.S., P.C., J.M.F.)
| | - Lia Lucas Neto
- Institute of Anatomy, Faculdade de Medicina, University of Lisbon (D.A.d.S., L.L.N., S.P.)
- Department of Neuroradiology, Hospital de Santa Maria/CHULN, University of Lisbon, Portugal (L.L.N., M.A.C.)
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico (A.A.)
| | - Ana Luísa Sousa
- Department of Neurology, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal (A.L.S.)
| | - Denis Gabriel
- Department of Neurology, Centro Hospitalar do Porto - Hospital Santo António, Portugal (D.G., M. Correia)
| | - Manuel Correia
- Department of Neurology, Centro Hospitalar do Porto - Hospital Santo António, Portugal (D.G., M. Correia)
| | | | - Sara Penas
- Institute of Anatomy, Faculdade de Medicina, University of Lisbon (D.A.d.S., L.L.N., S.P.)
| | - Mariana Carvalho Dias
- From the Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/CHULN, University of Lisbon, Portugal (D.A.d.S., M.C.D., P.C., J.M.F.)
| | - Manuel A. Correia
- Department of Neuroradiology, Hospital de Santa Maria/CHULN, University of Lisbon, Portugal (L.L.N., M.A.C.)
| | - Marta Carvalho
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto (M. Carvalho)
| | - Patrícia Canhão
- From the Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/CHULN, University of Lisbon, Portugal (D.A.d.S., M.C.D., P.C., J.M.F.)
- Instituto de Medicina Molecular, Lisbon (D.A.d.S., P.C., J.M.F.)
| | - José M. Ferro
- From the Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/CHULN, University of Lisbon, Portugal (D.A.d.S., M.C.D., P.C., J.M.F.)
- Instituto de Medicina Molecular, Lisbon (D.A.d.S., P.C., J.M.F.)
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Lee SK, Mokin M, Hetts SW, Fifi JT, Bousser MG, Fraser JF. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2018; 10:803-810. [DOI: 10.1136/neurintsurg-2018-013973] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 11/03/2022]
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Mehrpour M. Endovascular management of chronic internal carotid occlusion with Penumbra system. IRANIAN JOURNAL OF NEUROLOGY 2017; 16:50-52. [PMID: 28717436 PMCID: PMC5506758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Masoud Mehrpour
- 1 Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Ma J, Shui S, Han X, Guo D, Li TF, Yan L. Mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Acta Radiol 2016; 57:1524-1530. [PMID: 26953230 DOI: 10.1177/0284185116633912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity with substantial diagnostic and therapeutic dilemmas. The appropriate management of CVST remains to be defined. Purpose To evaluate the efficiency and safety of mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Material and Methods Twenty-three consecutive patients with CVST who were treated with mechanical thrombectomy using Solitaire AB stents between January 2013 and October 2014 were retrospectively analyzed. The headache intensity was evaluated according to the visual analogue scale (VAS), and neurological function was assessed using the National Institute of Health Stroke Scale (NIHSS). Follow-up data were available for all patients for 6-14 months. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) were performed at 3 and 6 months after neurointervention, and telephone interviews were performed monthly thereafter. The Wilcoxon signed-rank test was used to compare the evaluation data (VAS and NIHSS) at admission and discharge. Results Twenty-six Solitaire AB stents were used. No neurointervention-related complications were noted. The symptoms were significantly improved after neurointervention in all patients. The comparisons between the VAS and NIHSS evaluations at admission and discharge were significantly different ( P < 0.05). No recurrence was observed during the follow-up period. Conclusion Mechanical thrombectomy with Solitaire AB stents is safe and effective for the treatment of CVST and can significantly improve clinical symptoms. The occurrence of complications is low, and the prognosis is favorable.
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Affiliation(s)
- Ji Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Shaofeng Shui
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - XinWei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Dong Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Teng-Fei Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Lei Yan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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